evaluating the impact of an equity focused dashboard and clinical support

Conditions: Hypertension; Diabetes; Breast Cancer

Summary: in this project, the impact of providing a practice-level equity dashboard that displays ambulatory quality outcome metrics stratified by race and language to primary care providers at massachusetts general hospital (mgh) will be evaluated. provision of the dashboard data will be paired with additional clinical support focused on hypertension control among black, indigenous and people of color (bipoc) and patients with limited english proficiency (lep). the investigators hypothesize that there will be a improvement in hypertension control (primary outcome), diabetes control and breast cancer screening (secondary outcomes) among black, indigenous and people of color (bipoc) and patients with limited english proficiency (lep) in the intervention period compared to the control period.

a clinical program will be implemented to utilize the equity dashboard in routine clinical practice augmented by clinical support to address current disparities in hypertension control among mgh primary care patients who are black, indigenous and people of color (bipoc) as well as patients with limited english proficiency (lep). the clinical support will be provided by population health coordinators (phcs) and/or community health workers (chws). to evaluate the program, the investigators propose a stepped wedge design that will randomize the primary care providers to the provision of the equity dashboard and additional clinical support at different intervals. the primary reason to randomize the primary care providers is because the phcs and chws have limited capacity to contact and assist the patients in our primary care practices with poorly controlled hypertension and can only engage a limited number of patients at a time. the stepped wedge cluster-randomized study design will randomize providers in all 15 mgh primary care practices to receiving the intervention (i.e. equity dashboard with additional clinical support) in twelve groups. each step will be a one-month period. providers randomized to group 1 will receive the equity dashboard data as well as additional clinical support starting in step 1 while providers randomized to group 12 will receive the same intervention at the beginning of step 12 but receive usual care in steps 0-11. we will match providers in the opposite steps (e.g. group 1 vs. group 12, group 2 vs. group 11, etc.) by practice, baseline hypertension control rate, and the number of patients in their panel who are eligible for the intervention to ensure balance between data collected from the intervention periods and control periods. the stepped wedge design will allow for an open cohort (i.e. new patients of the providers allocated to the intervention can enter in subsequent steps) and a repeated measures data analysis with the same patients experiencing both control and intervention conditions.

Eligibility criteria:
\ inclusion criteria: • massachusetts general hospital primary care physician exclusion criteria: • practice leaders and equity steering committee members as they will all get access to the equity dashboard data. \ inclusion criteria: • uncontrolled hypertension and black, indigenous and people of color (bipoc) patients or limited english proficiency (lep). exclusion criteria: • not deemed appropriate for intervention by their primary care provider due to terminal illness, advanced dementia, etc.

Keywords: equity health disparities